The Doctor Will Text You Now
Patients Visit With Their Physicians Online as More Insurers Begin Paying for Digital Diagnoses
Wall Street Journal - Jane Rust woke up early one day last year and discovered that her left eye was red, swollen and itchy. So she logged on to her family doctor's Web site and typed a message describing her symptoms and asking what to do.
By mid-morning, the 61-year-old homemaker received an online response from her doctor with a diagnosis—conjunctivitis, or pink eye, probably contracted from a child in her Sunday-school class—and a prescription to pick up at the pharmacy. "I didn't have to disrupt my day," says Ms. Rust, who lives in Readyville, Tenn. "It's much more efficient."
Online Access to Medical Advice
This year, 39% of doctors said they'd communicated with patients online, up from just 16% five years earlier, according to health-information firm Manhattan Research, a unit of Decision Resources Inc. So far, the most common digital doctor services are the simplest ones, like paying bills, sending lab results and scheduling appointments. But patients like Ms. Rust are also using computers to deal with issues that usually require a trip to the doctor's office.
Though the number of physicians doing formal digital visits is still small, the practice of online care has grown as more health insurers begin paying doctors for treating patients virtually, albeit at a lower fee scale than for traditional in-office appointments. Among companies that now cover digital visits are Aetna Inc. and Cigna Corp., as well as Blue Cross Blue Shield plans in states including Florida, Hawaii and North Carolina. WellPoint Inc. and Humana Inc. are trying it in parts of the country, and may expand their coverage.
"If this service is valued, and there is payment for it, we will see many more primary-care physicians doing it," says Ted Epperly, a doctor in Boise, Idaho, who is president of the American Academy of Family Physicians. Dr. Epperly offers online visits to his patients, but currently just 3% of the physician group's members do. That low participation rate, however, doesn't reflect the widespread use of less-formal digital tools like email to communicate with patients.
Minneapolis-based Fairview Health System, a hospital and clinic operator, started offering digital visits around 18 months ago after it negotiated payments from some insurers with a large presence in the local market. About 85% of the digital visits between Fairview doctors and privately insured patients are now covered.
Chronic Condition Management
Doctors who offer digital visits say they generally are most effective for treating mild, simple conditions, often when patients are too busy or too far away to come to the office. Ailments most frequently treated online include sinus problems, cold and flu symptoms, urinary infections, and coughs. Other common conditions are back pain and sleep issues.
Louis Petrillo, 57, a psychologist in Westfield, N.J., says he regularly turns to his family's doctor, Robert Eidus, for online advice about his frail 90-year-old mother, who finds office visits difficult. His son who is away at college also used an online visit when he had sinus problems. "I can get into his virtual office anytime," says Dr. Petrillo. He feels the online care works well largely because Dr. Eidus knows his family members' regular health complaints.
But physicians typically won't treat certain conditions through online advice, particularly chest pain or other symptoms that may signal an emergency. Some state medical boards have rules that limit the use of digital visits, including requiring that doctors see patients in person before prescribing drugs. Even with minor ailments, many physicians will offer digital advice only to regular patients, for liability reasons and also because they feel that in-person visits are important to discuss broader health issues.
Insurers that cover digital visits often require the use of certain technologies or formats, in part to meet federal privacy requirements but also to ensure that a digital visit is legitimate. Companies say they had initial concerns that doctors might seek to boost their revenue by making excessive use of online communications, or classifying quick emailed messages as reimbursable visits.
But so far that hasn't happened, insurers say. Health plans also generally require that online visits be initiated by patients.
One format, offered by companies including McKesson Corp.'s RelayHealth and Medfusion Inc., requires patients to fill out interactive questionnaires that automatically generate follow-up queries based on the symptoms they initially describe. The answers go to the patient's doctor, who typically responds within a day.
Another type of digital doctor visit is more like secure email, with patients typing up a free-form message, often sent through a special Web site. Physicians often follow up with questions and then a written response within 24 hours. Medem Inc.'s Online Consultations follows this format.
Another option is live online visits, using technology from companies such as American Well Corp. The firm has created an encrypted setup for real-time interaction between doctors and patients, using Web video, live chat or a phone conversation connected through a secure computer system. OptumHealth, a unit of UnitedHealth Group Inc., is rolling out the American Well system nationally.
Daniel Nishikata, 28, of Pearl City, Hawaii, says he likes being able to get real-time care fast and late at night, when he's often awake because he works the graveyard shift at a pharmacy.
One Sunday at 2 a.m., Mr. Nishikata logged on to the American Well system sponsored by his insurer, nonprofit Hawaii Medical Service Association, which provides Blue Cross Blue Shield coverage. The system allows patients to communicate with doctors who are on call. Through the online visit, for which he owed a $10 co-pay, Mr. Nishikata got a renewal of his sleep-drug prescription, which he picked up the following Monday morning.
Who Pays What?
When an insurer doesn't pay for online visits, some doctors are asking patients to pay around $20 to $35—far less than an in-person visit. The lower rate reflects the fact that digital visits typically are less demanding and require less of a doctor's time.
The reduced rate appeals to patients like Shellie Kemp, 30, of Port St. Lucie, Fla. Ms. Kemp lost her banking job last year, and she has no health insurance through her work as a substitute teacher. Her husband has a high-deductible plan. When the couple came down with flu-like symptoms recently, Ms. Kemp filled out online questionnaires for both of them about their symptoms. Their doctor, Lisa Rankin, responded by prescribing antibiotics. The Kemps were charged $30 each. "It gives you a chance to have your doctor treat you, and it's affordable," says Ms. Kemp.
Doctors also use digital communication to track patients with chronic conditions like diabetes who can regularly send in their blood-sugar readings. Shawnda Johnson, an Oakland, Calif., pediatrician with the big nonprofit Kaiser Permanente, has used its secure email to monitor a patient she had diagnosed with attention-deficit disorder. Instead of bringing him in to the office, the boy's parents would regularly send updates about his condition. Dr. Johnson adjusted his medication dose based on the feedback.
Know When to Get a Face-To-Face Consultation
Conditions that may be ambiguous don't lend themselves to online diagnosis. Some doctors say they won't diagnose complaints such as vertigo and ear aches without an exam. Melissa Gerdes, a family doctor in Whitehouse, Texas, won't treat abdominal pain in an online visit. "How are you supposed to tell a bladder infection, or appendicitis, or an aneurysm?" she says. "There are too many different potential causes for pain in the belly area."
Of course, patients can't always tell what's urgent. Gynecologist James R. Frede, who practices in Wailuku, Hawaii, grew concerned about six weeks ago when a patient, during a live online conversation with him, described serious abdominal pain that left her curled up in bed. She'd recently learned she was pregnant. Dr. Frede, worried that her symptoms could signal an ectopic, or tubal, pregnancy, urged her to get to an emergency room. Dr. Frede met her there and confirmed that she did have the condition. The woman was treated and recovered.
- The Second Annual Medical Innovation and Consumer Strategies Conference:The Future of Healthcare, Wireless and Consumer Healthcare – September 15, 2010
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